the nhs five year-steve thomas presentation
TRANSCRIPT
Sharing Clinical ServicesOptions & Opportunities
Steve Thomas | Director
Caring | Learning | Transparency | ExcellenceSWLEOC is a Partnership between St George’s University Hospitals NHS FT, Kingston Hospital NHS FT,
Croydon Health Services NHS Trust and Epsom & St Helier University Hospitals NHS Trust.
Look me up in the year 2000…
SW London had issues.
Across the UK, T&O was (and still is) one of the worst performing specialties for wait times.
SW London was the worst performer.
The sector was losing money.
Quality was suffering (LOS variable across the sector).
Pathways were inconstant and patient experience often poor.
Caring | Learning | Transparency | ExcellenceSWLEOC is a Partnership between St George’s University Hospitals NHS FT, Kingston Hospital NHS FT,
Croydon Health Services NHS Trust and Epsom & St Helier University Hospitals NHS Trust.
South West London…
Caring | Learning | Transparency | ExcellenceSWLEOC is a Partnership between St George’s University Hospitals NHS FT, Kingston Hospital NHS FT,
Croydon Health Services NHS Trust and Epsom & St Helier University Hospitals NHS Trust.
Secondary Care Options
Option 1 Option 3Option 2
Caring | Learning | Transparency | ExcellenceSWLEOC is a Partnership between St George’s University Hospitals NHS FT, Kingston Hospital NHS FT,
Croydon Health Services NHS Trust and Epsom & St Helier University Hospitals NHS Trust.
..Working Together to create…
The concept of a dedicated elective orthopaedic facility was clinically inspired but captured the imagination of the four SWL CEOs.
Clinical pathway redesign started 2002
Building work started 2003.
The centre opened 2004
Caring | Learning | Transparency | ExcellenceSWLEOC is a Partnership between St George’s University Hospitals NHS FT, Kingston Hospital NHS FT,
Croydon Health Services NHS Trust and Epsom & St Helier University Hospitals NHS Trust.
…Elective Orthopaedic Centre
Strategy and business is managed through a Partnership Board.
Risk is shared
Governance is managed through Epsom & St Helier
Both the Dalton Review and the GIRFT Report use swleoc as one example of partnership working.
Caring | Learning | Transparency | ExcellenceSWLEOC is a Partnership between St George’s University Hospitals NHS FT, Kingston Hospital NHS FT,
Croydon Health Services NHS Trust and Epsom & St Helier University Hospitals NHS Trust.
What we do…
• THR / TKR, complex & revision• Soft tissue shoulder, knee• Spines (lumbar, up to x3 level with cages)• Foot and ankle• Young adult hip• Hands X
Caring | Learning | Transparency | ExcellenceSWLEOC is a Partnership between St George’s University Hospitals NHS FT, Kingston Hospital NHS FT,
Croydon Health Services NHS Trust and Epsom & St Helier University Hospitals NHS Trust.
SWLEOC
Established by the four South West London acute Trusts working in partnership to deliver a strategic change in the delivery of planned orthopaedic care, SWLEOC pursues the delivery of a high quality, cost efficient elective orthopaedic services to match the best in the world.But did we get it right…?
The Opportunity…
The Good and the Bad
Enhanced RecoveryPartnership Programme
Financial melt down in first 2 years,cost base… what is that?
5 waiting lists into one!
Introduction of tariff??!!
Theatre scheduling processes4 surgeons asked to leave
Loss of collaboration with HSSLots of ‘politics’ with one Partner
Supply chain problems (HSDU)Junior Doctors training issues
‘Centre of Excellence’
Strong Consultant buy-in
Open door management policy
5th best healthcare employer (2009)Happy patients
Happy commissioners
Outcomes researchLow lengths of stay
No MRSAHigh theatre utilisation in the end
Built new theatre (2010)
Transition for Improvement
An NHS Treatment Centre operated through a Partnership between: St George’s Healthcare NHS Trust; Kingston University Hospital NHS Trust; Croydon Healthcare NHS Trust and hosted through ; Epsom & St Helier University Hospitals NHS Trust
SWLEOC Partnership
Board
CCGs
EOC Senate
Operational Committee
Business Meeting
Risk Committee
(HSQ)
Clinical Governance Committee
Department Leeds
Department Team Meetings
Theatre Planning
Patient Forum
Medical Council
Short Notice Cancellation
SWLEOC Organogram
Research & Education
ESTH
Staff Forum
Caring | Learning | Transparency | ExcellenceSWLEOC is a Partnership between St George’s University Hospitals NHS FT, Kingston Hospital NHS FT,
Croydon Health Services NHS Trust and Epsom & St Helier University Hospitals NHS Trust.
(hosted by ESTH)
KHFT
SGHFT
CHS
ESTH
MEMBERS
CUSTOMER CONTRACTS
KHFT
SGHFT
CHS
ESTH
CUSTOMERS
CON
SORT
IUM
AG
REEM
ENT
TRUST SERVICE AGREEMENTS
KHFT SGHFT CHS ESHT
SUPPLIERS
Consortium AgreementSets out mutual risks and obligations between partnersCustomer Contracts Between partners and SWLEOC (via host partner) for provision of orthopaedic servicesTrust Service Agreement • between partners and host for provision of doctors and effective governance of doctors• between host and partners for provision of support services, hosting non consultant staff as employees and provision of facilities
and equipment.
SWLEOC JV – Legal Structure
DRAFT
Third Party Providers
CCG Contract
CCG Contract
CCG Contract
CCG Contract
Governance Arrangements
KHFT SGHFT CHS ESTH
Partner Trust Boards
Reserved matters and regular reporting
SWLEOC Board
Independent Chair
CEO CHS*
CEO KHFT*
CEO SGHFT*
CEO ESTH*
swleocDirector
Medical Director
SWLEOC* Voting rights – should chair have casting vote on SWLEOC Board?
Nurse Director
CHS* KHFT* SGHFT* ESTH*swleoc
Director*Surgical
Director*General
Manager*
SWLEOC Ops Board (sub committee of SWLEOC Board)
Stra
tegy
Tacti
cal
Del
iver
y
SWLEOC JV – Governance Structure
Governance Arrangements DRAFT
Caring | Learning | Transparency | ExcellenceSWLEOC is a Partnership between St George’s University Hospitals NHS FT, Kingston Hospital NHS FT,
Croydon Health Services NHS Trust and Epsom & St Helier University Hospitals NHS Trust.
Opportunities
£4.2M Deficit28% of turnover
…howeverThe sector was loosing £7M PA before SWLEOC
In 2004/05
Caring | Learning | Transparency | ExcellenceSWLEOC is a Partnership between St George’s University Hospitals NHS FT, Kingston Hospital NHS FT,
Croydon Health Services NHS Trust and Epsom & St Helier University Hospitals NHS Trust.
Theory of Constraints (Joint Replacement example)
£90 £50 £4,100 £220 £200 a day
Pre-Assessment Pre-Theatre
Theatre
PACU Wards
Home
£45
Services, fixed costs, admin & surplus £727
Sharing the Risk LEAN Healthcare
Caring | Learning | Transparency | ExcellenceSWLEOC is a Partnership between St George’s University Hospitals NHS FT, Kingston Hospital NHS FT,
Croydon Health Services NHS Trust and Epsom & St Helier University Hospitals NHS Trust.
• Three Pillars underpinning the EOC
Sharing the Risk
Quality of care
delivered
Education of staff
& PatientsResearch
EOC‘A centre of excellence’
Underpinned by Financial Realism
Caring | Learning | Transparency | ExcellenceSWLEOC is a Partnership between St George’s University Hospitals NHS FT, Kingston Hospital NHS FT,
Croydon Health Services NHS Trust and Epsom & St Helier University Hospitals NHS Trust.
Sharing the Risk
Cumulative Complications Primary THR with 95% CIs
3.10%
1.70%
4%
1.33%
0.30%
1.36% 1.39%1.27%
0.60%
2.11%
0.88%
0.21%
0.57%
0.85%
0%
1%
2%
3%
4%
5%
Joint infection(2 yrs)
Dislocation (2yrs)
Periprostheticfracture (2
years)
Revision(2yrs)
PE (6 mo) DVT (6 mo) Mortality (6mo)
Stroke (6wks)
Nervedamage (6
wks)
MI (6 weeks)
Pro
po
rtio
n
RCS/BOA (n= 6,032) EOC08-10 (n=3,311)
Caring | Learning | Transparency | ExcellenceSWLEOC is a Partnership between St George’s University Hospitals NHS FT, Kingston Hospital NHS FT,
Croydon Health Services NHS Trust and Epsom & St Helier University Hospitals NHS Trust.
Sharing the Risk
Complications, Oxford , Euroqol, patient satisfaction with outcome and length of stay for
1. Surgeon performance 2. EOC overall performance 3. EOC minus surgeon performance
Surgeons Report
A N Other MSK(own operating committee with
links to local Trusts)A N Other MSK(own operating committee with
links to local Trusts)
Partnership Board Membership gives access to R&D, operating model and support,
procurement benefits, financial kick back
(own operating committee)
CCG ‘B’ MSKworking with a re configured
by CCG
A N Other MSK(own operating committee with
links to local Trusts) CCG ‘C’ MSK
(existing staff and service)
CCG ’A’ MSKcontracted to provide service
St Elsewhere EOC
(own operating board)
St Elsewhere EOC
(own operating board)
St Elsewhere EC
(own operating committee)
Future potential
Different specialities at different partner
hospitals.
Using swleoc as a template to work alongside other hospitals further
afield
